Cost-effectiveness of palivizumab against respiratory syncytial viral infection in high-risk children in Austria

Objective: The aim of this study was to estimate the cost-effectiveness of palivizumab, a monoclonal antibody against severe respiratory syncytial virus infection, in high-risk infants in Austria.Methods: A decision tree model was developed to determine cost-effectiveness in infants born prematurely (≤35 weeks' gestational age), those with bronchopulmonary dysplasia (BPD), and children with congenital heart disease (CHD). The primary perspective of the analysis was that of the compulsory health insurance fund. The societal perspective was also considered.Results: From the health insurance fund perspective, including the costs associated with asthma, the incremental cost-effectiveness ratio (cost per qualityadjusted life year [QALY] gained) without discounting was estimated to be €4484 (2006 euros) in preterm infants, €6719 in children with BPD, and €2668 in the CHD population. When discounted, these figures increased to €14,439, €21,672, and €9754, respectively. The results from the societal perspective were substantially more cost-effective in all populations. The undiscounted cost per QALY was €1435 in preterm infants, €4881 in children with BPD, and €251 in the CHD group. Discounted figures were €4623, €15,741, and €917, respectively. Sensitivity analyses confirmed the robustness of the model, and scenario analyses found that the inclusion of indirect costs led to further improvement in the cost-effectiveness outcomes for palivizumab.Conclusion: Use of palivizumab was cost-effective compared with no prophylaxis in high-risk infants and children in Austria.